OB Chapter 16: Labor and Birth Process

Question 1

The Intrapartum period begins with __________ and ends with _______________

Answer 1

Regular Uterine Contractions; the delivery of the placenta

Question 2

Process is called _________

Answer 2

labor

Question 3

______________ is conclusion of pregnancy to start of extrauterine life for newborn.

Answer 3

Childbirth

Question 4

Maternal Factors that trigger Labor:

1. ________ which causes release of prostaglandins which brings on ________
2. Pressure on the cervix which stimulates the release of __________ by the maternal___________
3. _______ increases, bringing on uterine response
4. ________ decreases and helps relax smooth muscles
5. _______ and ________ work together to to inhibit calcium binding and in muscle cells to increase intracellular Ca levels which activate uterine contractions

Answer 4

1. Uterine muscle stretching; uterine contractions
2. Oxytocin; posterior pituitary gland
3. estrogen
4. progesterone
5. oxytocin; Progesterone

Question 5

When _______ levels are inhibited it causes uterine contractions that serve the purpose of dilating and effacing the cervix

Answer 5

Calcium levels

Question 6

Fetal Factors that Contribute to Labor Onset:

1. ________ and deterioration triggers the initiation of contractions
2. ____________ increases and decreases placental _______ and increases the release of _______
3. Fetal membranes produce ________ which stimulate uterine contractions

Answer 6

1. Placental aging
2. Fetal cortisol concentration; progesterone; prostaglandins
3. prostaglandins

Question 7

_________ is the descent of the fetus into the bony pelvis about two weeks before the onset of labor.

Answer 7

Lightening

Question 8

_______ do not usually experience lightening

Answer 8

multigravidas

Question 9

__________ are irregular, false labor contractions

Answer 9

Braxton Hicks

Question 10

The purpose of Braxton Hicks:

Answer 10

increase oxygenation of the uterine muscle and get the uterus ready for labor

Question 11

_______ also known as nesting, refers to the need to put everything in order

Answer 11

Maternal energy surge

Question 12

Cervical changes that suggest impending labor include:
1.
2.
3.

Answer 12

1. Ripening (softening)
2. dilating
3. Bloody show/ loss of mucus plug

Question 13

GI changes that suggest impending labor include:
1.
2.
3.

Answer 13

1. Diarrhea
2. Indigestion
3. Nausea

Question 14

Lower backache leading up to delivery is caused by ______ and ______

Answer 14

hormone called Relaxin; the fetus being lower

Question 15

5 P’s of factors affecting labor:

Answer 15

1. Powers (physiological forces)
2. Passageway (maternal pelvis)
3. Passenger (fetus and placenta)
4. Psyche (woman’s response to labor)
5. position (mother and baby)

Question 16

What is included in “powers”

Answer 16

physiological forces of labor including uterine contractions and maternal pushing efforts

Question 17

What is meant by “passageway”

Answer 17

maternal pelvis (gynecoid), soft tissues (vaginal rugae), and pelvic station

Question 18

What is meant by the “passenger”

Answer 18

Everything about the fetus and the placenta: how many fetuses, size, gestational age, and position

Question 19

what is meant by “psyche”

Answer 19

the woman’s psychological responses to labor, preparation, sedation, and anesthesia

Question 20

what is meant by “position”

Answer 20

maternal labor positions used to promote labor (upright, walking, ball-bouncing etc)

Question 21

Uterine contractions are described by:
1.
2.
3.

Answer 21

1. Frequency (in minutes)
2. duration (in seconds)
3. intensity (mild, moderate, strong)

Question 22

How is the duration of uterine contractions measured

Answer 22

beginning to end of a single contraction

Question 23

how is the frequency of contractions measured

Answer 23

beginning of one contraction to the beginning of the next contraction

Question 24

uterine relaxation between contractions is important because:

Answer 24

it allows fetal oxygenation by allowing blood flow from the uterus to the placenta to be restored

Question 25

Measuring the intensity of the contractions is done by palpating the fundus during_______

Answer 25

acme (peak of the contraction)

Question 26

what will a mild, moderate, and strong intensity contraction feel like when palpating the fundus

Answer 26

mild: tip of your nose moderate: chin strong: forehead

Question 27

external contraction monitoring uses _______which is a pressure sensitive device that is applied to the uterine fundus

Answer 27

tocodynamometer

Question 28

external contraction monitoring gives information about _____ and ______ but might not give accurate information about _______

Answer 28

frequency; duration; intensity

Question 29

intrauterine pressure catheter is inserted when and where?

Answer 29

after the membranes have ruptured the IUCP is inserted through the cervix

Question 30

how is IUCP measured ? (units)

Answer 30

mmHg

Question 31

___________ is opening of the cervical Os and is expressed in centimeters (0-10)

Answer 31

dilation

Question 32

________ is the shortening and thinning of the cervix

Answer 32

effacement

Question 33

the amount of cervical effacement is usually measured in _________ related to ________

Answer 33

percentage; the length of the cervical canal as compared with a non-effaced cervix.

Question 34

a cervix that has thinned to 3/4 of the normal length of a cervix would be ________ % effaced

Answer 34

25%

Question 35

the first stage of labor begins with ______ and concludes when______

Answer 35

onset of true labor; cervical effacement and dilation are complete

Question 36

______ usually efface before they dilate

Answer 36

primiparas/ nulliparas

Question 37

_______ usually efface and dilate at the same time

Answer 37

multiparas

Question 38

three phases of stage 1 of labor: 1. 2. 3.

Answer 38

1. early: 0-3 cm 2. middle: 4-7 cm 3. transition: 8-10 cm

Question 39

normal female pelvis that is best suited for childbirth is:

Answer 39

Gynecoid

Question 40

_____ pelvis resembles a typical male pelvis and has a triangular or heart shaped inlet

Answer 40

android

Question 41

_______ refers to the level of the presenting part in relation to the maternal ischial spine

Answer 41

Station

Question 42

ischial spine = station:

Answer 42

0

Question 43

when the presenting part lies above the ischial spine it is:

Answer 43

at a minus station

Question 44

a station of -5 means:

Answer 44

the presenting part is at the pelvic inlet

Question 45

a positive station indicates:

Answer 45

the presenting part has descended past the ischial spines

Question 46

a station of +4 means:

Answer 46

the presenting part is at the pelvic outlet

Question 47

soft tissue of pelvic floor allows for_________

Answer 47

fetus anterior rotation

Question 48

how to strengthen Rugae

Answer 48

Kegals

Question 49

_________ is normal fetal presentation

Answer 49

cephalic

Question 50

a cephalic presentation means:

Answer 50

the fetal head will be the first part to come into contact with the maternal cervix

Question 51

four types of cephalic presentation:

Answer 51

1. vertex 2. military 3. brow 4. face

Question 52

in this cephalic presentation the fetal head is fully flexed (chin is tucked down to chest). It is most frequent and optimal position

Answer 52

vertex

Question 53

in this cephalic presentation the fetal head presents in a neutral position (not flexed or extended). top of the head will be the presenting part

Answer 53

military

Question 54

in this cephalic presentation the fetal head is partly extended- unstable and converts to flexed or fully extended position eventually

Answer 54

brow

Question 55

in this cephalic presentation the fetal head is fully extended (back of head is near extended toward fetal spine)

Answer 55

face- babies face will be the presenting part

Question 56

``` Components of vertex presentation: 1. 2. 3. 4. ```

Answer 56

1. head enters birth canal first 2. fetal face is backward (toward mom's spine) 3. arms crossed 4. chin and neck bent forward toward chest

Question 57

______ is the fetal head's ability to change shape in order to come through the birth canal

Answer 57

molding

Question 58

__________ refers to fetal position and the relationship of fetal parts to one another

Answer 58

fetal attitude (posture)

Question 59

_________ refers to the spine of fetus in relation to the spine of the mother

Answer 59

fetal lie

Question 60

__________ refers to the part of the fetus that enters the pelvic inlet

Answer 60

fetal presentation

Question 61

________ is the largest part of the fetus to come through birth canal

Answer 61

fetal head

Question 62

the fetal skull is made up of:

Answer 62

2 parietal bones; 2 temporal bones; 1 occipital bone

Question 63

_______ are membranous spaces between bones that are used to determine positioning of the head

Answer 63

sutures

Question 64

________ are intersections of the sutures

Answer 64

fontanelles

Question 65

normal biparietal diameter of fetus (BDP)

Answer 65

9.25-9.5 cm

Question 66

a ______ presentation occurs when the fetal buttocks enters the maternal pelvis first

Answer 66

breech

Question 67

with ___________ there is an increased risk for umbilical cord prolapse

Answer 67

breech presentation

Question 68

the three types of breech presentation include:

Answer 68

1. frank 2. complete (full) 3. footling

Question 69

______ is the most common type of breech presentation and is when the fetal legs are completely extended upward toward the fetal shoulders

Answer 69

Frank

Question 70

_______ is a breech position when the fetal legs are flexed (crisscrossed)

Answer 70

complete

Question 71

________ is a breech position when the fetal legs are extended and one or both feet are the presenting parts

Answer 71

footling

Question 72

four landmarks on the fetus that are used to describe position

Answer 72

1. occiput 2. mantum (chin) 3. sacrum 4. acromion process

Question 73

for a vertex presentation we use _ to describe fetal position

Answer 73

O- occiput

Question 74

for a face presentation we use _ to describe fetal position

Answer 74

M- mantum (chin)

Question 75

for a breech presentation we use _ to describe fetal position

Answer 75

S- sacrum

Question 76

for a shoulder presentation (transverse) we use _ to describe fetal position

Answer 76

A- acromion position of the shoulder

Question 77

what does "R/L" refer to when describing fetal position

Answer 77

right or left side of the maternal pelvis

Question 78

what does "A/P/T" stand for when describing fetal position

Answer 78

whether the presenting part is Anterior, Posterior, or Transverse in relation to the maternal pelvis

Question 79

side effects of Lightening (5 major s/e)

Answer 79

1. leg cramps 2. increased pelvic pressure 3. increased urinary frequency 4. increased venous stasis (peripheral edema) 5. increased vaginal secretions

Question 80

amniotic fluid should be ______ and _____ when amniotic sac ruptures

Answer 80

clear; odorless

Question 81

yellow-green tinged amniotic fluid might indicate______ or ________

Answer 81

infection; fetal passing of meconium

Question 82

three different tests used to confirm presence of amniotic fluid:

Answer 82

1. Nitrazine tape test 2. AmniSure 3. fern

Question 83

weight loss leading up to labor

Answer 83

there is a reduction of fluid retention toward the end of pregnancy because of changes in levels of estrogen and progesterone so mommy can lose up to 3 pounds

Question 84

true labor versus false labor

Answer 84

true labor contractions lead to progressive dilation and effacement of the cervix true labor contractions occur with regularity and increase in frequency, duration, and intensity